1What Is the C116 OHIP Code?
C116 refers to the OHIP billing code for repeat consultations in a critical care setting, specifically for non-emergency hospital in-patient services. This service allows physicians to revisit a patient for a re-evaluation when there is a significant development in the patient’s condition after another physician’s intervention.
Such consultations are crucial when patients in critical care settings experience changes in their health status. Typically, it involves a scenario where the ward team requests another critical evaluation of a patient previously assessed by the critical care service, usually due to a deterioration in the patient's condition.
Physicians often miss billing this code properly due to inadequate documentation of the referral or misunderstanding of its eligibility criteria.
2Related Codes
| Code | Name | Frequency | Description |
|---|---|---|---|
| A116 | Repeat consultation | No specified limits | Critical care repeat consultation for non-hospital settings. |
| A710 | Comprehensive critical care medicine consultation | Subject to consultation frequency limits | Comprehensive assessment in critical care. |
| A715 | Consultation | Subject to consultation frequency limits | Standard consultation in critical care. |
| A915 | Limited consultation | Limited consultations are billed as needed | Brief assessment in critical care. |
3Eligibility Requirements
C116 can be billed in non-emergency hospital in-patient settings under the Critical Care Medicine listing.
- Setting: The consultation must occur for non-emergency hospital in-patients within critical care.
- Request: A new written request from a referring physician, nurse practitioner, or dental surgeon is mandatory for each consultation.
- Documentation: Keep a copy of the written request in the medical record unless the consultation occurs in an institution with shared medical records.
To qualify, C116 requires adherence to the same consultation criteria, including new written requests. Virtual consultations are eligible only via video, billed as C116A.
4What Your Clinical Note Must Show
Ensure a written request is documented in the patient's medical record.
- Signed by the referring physician, nurse practitioner, or dental surgeon.
- Retained in the consulting physician's records unless in a shared medical record environment.
5Weak vs. Strong Note Examples
The strong note provides detailed context, including patient identifiers, referring physician details, and a thorough assessment — all crucial for billing purposes.
Patient revisited for evaluation following recent deterioration; advised by ward staff. No formal referral documented.
Patient: John Doe, HN: 12345. Repeat consultation requested by Dr. Smith (General Medicine) due to patient’s respiratory decline post-surgery on [date]. Objective findings include [symptoms/exams]. Assessment and recommendations for care adjustment provided.
- Includes comprehensive referral details.
- Documents clinical findings and recommendations.
